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目的：研究ＴＩＰＳＳ加改良Ｓｕｇｉｕｒａ术对门静脉高压症患者门脉循环、肝外门－体分流和肝功能的影响，评价这一联合治疗模式的临床适用性。 方法：对本组１４例门脉高压症伴食管静脉曲张患者，进行ＴＩＰＳＳ加改良Ｓｕｇ－ｉｕｒａ 术治疗前后的９９ｍ Ｔｃ 动态显像自身对比研究。 结果：术前患者的肝、门静脉开始显影时间分别为（５８．６７±１３．７１） ｓ、（５３．３３±１０．８２） ｓ；门－体分流指数（ＳＩ）为（８７．３６±６．２５）％ ；门静脉压力为（４２．８９±３．３３）ｃｍ Ｈ２Ｏ 。ＴＩＰＳＳ术后患者肝、门静脉显影时间分别提前到（４３．１１±８．４３）ｓ和（３９．５６±８．５９）ｓ（Ｐ＜ ０．０１）；ＳＩ下降为（７５．３０±６．９９）％ （Ｐ＜ ０．０１）。门静脉压力为（３４．００±２．６５）ｃｍ Ｈ２Ｏ（Ｐ＜ ０．００１）。改良Ｓｕｇｉｕｒａ术后肝、门静脉的开始显影时间又有明显降低，ＳＩ无显著变化。肝放射性－时间曲线斜率上升为４．８２±３．１７（Ｐ＜ ０．０１）。术后２ 周门静脉压力比ＴＩＰＳＳ术后明显降低。肝功能无明显改变。 结论：ＴＩＰＳＳ可降低门－体分流指数，改善门静脉血液循环；改良Ｓｕｇ－ｉｕｒａ 术会增加门静脉入?
Objective: To study the effect of TIPSS plus modified Sugiura operation on portal circulation, extrahepatic portal-to-body shunt and liver function in patients with portal hypertension and to evaluate the clinical applicability of this combination therapy. Methods: This group of 14 cases of portal hypertension patients with esophageal varices, TIPSS plus modified Sug-iura surgery before and after 99m Tc dynamic imaging contrast study. Results: The preoperative imaging time of hepatic and portal vein were (58.67 ± 13.71) s and (53.33 ± 10.82) s, respectively. The portal-to-body shunt index (SI) was 87.36 ± 6.25)%; portal vein pressure was (42.89 ± 3.33) cm H2O. The time of hepatic and portal vein imaging in patients with TIPSS advanced to (43.11 ± 8.43) s and (39.56 ± 8.59) s, respectively (P <0.01), and the SI decreased to (75.30 ± 6 .99)% (P <0.01). Portal pressure was (34.00 ± 2.65) cm H2O (P <0.001). Improved Sugiura postoperative liver and portal vein start time significantly reduced, SI no significant change. The slope of the liver radioactivity-time curve increased to 4.82 ± 3.17 (P <0.01). Portal pressure was significantly lower at 2 weeks after TIPSS. No significant change in liver function. Conclusion: TIPSS can reduce the portal-to-body shunt index and improve portal blood circulation. Improved Sug-iura operation will increase portal vein invasion.